Nail in The Head Angiogram

Middle aged man working at home in an enclosed space with a nail gun. With the barrell of the gun behind his head, he accidentally pulled the trigger. A 4-inch nail was driven fully in, as shown by the above radiograph. The trauma service asked for an angiogram to assess whether any vascular structures had been lacerated.

Venous phase arteriogram in the lateral projection shows the nail missed the transverse and sigmoid sinuses.

Mid-arterial phase injection into the right vertebral artery demonstrates the nail missed the arteries in the posterior fossa.

Oblique projection of an injection into the vertebral artery again show the nail missed any venous structures. The patient was taken to the operating room and a 1-inch in diameter plug of bone around the nail was removed along with the nail. The nail was removed from the plug of bone and the plug replaced. The patient was discharged without neurologic impairment.